Triplane fractures of the adolescent ankle commonly require operative management. A number of classification systems exist showing a variety of fracture patterns, making fixation planning complex. Our institute has previously presented a classification system that simplifies the fracture pattern. Our aim was to find a fixation method that could be used in all cases.

We devised a universal screw trajectory for the epiphyseal fracture based on a partially threaded screw placed medial-to-lateral at 20 degrees to the inter-malleolar axis of the ankle. We retrospectively reviewed the axial CT images of 59 consecutive operatively managed triplane fractures from a single institute to simulate the placement of the screw.

In all 59 subjects, the simulated universal screw placement was in a satisfactory position to adequately, and safely, reduce the fracture. Two cases were classified as ‘Tillaux variants’, which are classically managed with a lateral-to-medial screw, but they were deemed to be potentially suitable for the universal screw, indeed in one case the treating surgeon used a medial-to-lateral screw and had a successful outcome.

Our classification system demonstrates a reproducible fracture line that is amenable to a universal screw fixation method in the world's largest published triplane series. It offers a low-tech solution to a difficult problem. This could simplify the preoperative plan and obviate the need for a CT scan, which is relevant to departments treating populations without access to such resources.

The aim of this study is to discuss the results of intramedullary devices in the management of paediatric radial neck fractures and to suggest methods to avoid the pitfalls of the technique.

30 patients with isolated Judet III and IV fractures were included in this retrospective study. The method of reduction was reviewed. The final results were graded using the Metaizeau functional scoring system and Oxford Elbow score.

Intramedullary K wires were used in 10 patients and blunt tipped TENS nails in 20 patients. The complications seen were radiocapitellar joint penetration-6 cases at mean 4.87 weeks, redisplacement − 6, radial epiphyseal sclerosis − 5 and heterotopic ossification − 1 case. The functional result was good to excellent in 24 of 30 cases(80%). The mean Oxford Elbow score was 44.32. The mean follow-up was 40.11 months.

Intramedullary K wires may result in radiocapitellar joint penetration. Blunt tipped devices should not be used as purely fixation devices as they may not prevent redisplacement. Minimal redisplacement does not affect the functional outcome.

Regular follow-up until atleast 6 weeks is essential. Patients who have a Judet IV fracture and need open reduction should be closely followed up and given a guarded prognosis.

Purpose

Plating remains the most widely employed method for the fixation of displaced diaphyseal clavicle fractures. The purpose of this study was to assess the efficacy and outcomes of diaphyseal clavicle fractures treated with intramedullary fixation using the Rockwood clavicle pin.